The pudendal nerve begins in the lower back, which is called the sacral area and as it moves downward, it splits into three separate sections or branches. Each branch helps provide important sensation and function. One branch affects the anus, another affects the genitals and most sensations involved in sexual pleasure, and the third branch supplies sensation to the perineum or the area located between vaginal opening or testes and anal opening.
Some may be familiar with the pudendal nerve because in childbirth one pain management option is a nerve block, which creates numbing or loss of sensation in the genital area and other regions. Some obstetricians and anesthesiologists may prefer this to an epidural block depending on circumstances. By far the epidural is more common than a pudendal block, but there are certainly indications for pudendal blocks in some labor and delivery scenarios.
Principally, most people do not want this nerve’s sensation dulled in any way because of the areas on which it has an affect. In large part, things like orgasm are directly tied to the function of the pudendal nerve, and some people with a damaged nerve could also have bowel movement difficulty, develop constipation, or have issues with the way the bladder functions. However, in some cases, a pudendal block may be a desirable pain management strategy, if it addresses serious and significant pain in the genital region. Such blocks aren’t just for childbirth, and might be used to diagnose pudendal nerve damage that results in pain.
In some cases, childbirth or other injuries may directly affect the nerve. This is often short-term damage, and the main symptom could be loss of sensation. This degree of sensation loss varies, but it could impact sexual and bowel movement function. Alternately, damage to the nerve, or any scenario that compresses the nerve, could result in pain and discomfort in different parts of the pelvis. This may be known as nerve entrapment and could result in the very painful pudendal neuropathy.
Pudendal neuropathy is viewed as a challenging condition to treat, and diagnosis isn’t always immediate unless clear cause of injury is present. The principal symptoms of this condition are pain in one or more of the genital areas that the nerve innervates. One useful diagnostic after ruling out possible compression causes from things like cysts or tumors is a pudendal block because complete stoppage of pain would indicate involvement of the nerve. Once diagnosis is reached, people have several treatment options, but total cure is only achieved in approximately half the cases, and many people must resort to multiple pain management strategies to control the condition. It is fortunate the condition is rare and many people who have slight damage to the pudendal nerve (as from childbirth) recover fully and never move on to develop neuropathy.